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What does 'gluten free' really mean?

Gluten-free products have increased in popularity in recent years, but with so many "-free" products on the market, it can be hard to know how "free" a product really is, unless there is standardized labeling.

Avoiding gluten is important for people with celiac disease, as they can experience serious adverse effects if they consume it. Others prefer to avoid it because they feel better or believe it is healthier to do so.

Gluten is what gives dough its elasticity. It gives shape, strength, and texture to bread and other grain products.

Some gluten-free foods are naturally gluten-free and healthy, for example, apples or sweet potatoes. Other gluten-free foods are processed to remove gluten or processed without gluten-free containing ingredients but may still be high calorie, full of additives and low in fiber.

Gluten-free bread for example, is a practical alternative for a person with celiac disease, because it contains no gluten or only minor traces of it.

What does 'gluten-free' mean?

To be gluten free, a food must contain less than 20ppm of gluten.

In August 2013, the United States Food and Drug Administration (FDA) issued a new definition for "gluten-free" for the purpose of food labeling.

For a food to be labeled as gluten-free, the FDA states that it must contain no more than 20 parts per million (ppm) of gluten.

The choice of 20 ppm rather than zero ppm is because current technology cannot reliably measure gluten presence below 20ppm.

Evidence suggests that trace amounts of gluten, defined as up to 20 ppm, do not have adverse health effects on people with celiac disease.

The use of the label is voluntary for manufacturers, but if they use it, consumers will know that their products really are gluten free.

Any product that has less than 20 ppm of gluten can carry the following labels:

Gluten-free

Free of gluten

Without gluten

No gluten

People who wish to avoid all traces of gluten will choose to eat rice instead of cereals that might contain it.

Those who can tolerate traces of gluten can consume cereal-based products where the gluten has been removed, but they need to know that the level of gluten is minimal. The labeling system can help these people.

"An ingredient that has been derived from a gluten-containing grain can be labeled as "gluten-free" if it has been processed to remove gluten and use of that ingredient results in the presence of less than 20 ppm of gluten in the food."

FDA

A food that is by nature gluten-free does not have to carry "gluten-free" label, but it can do so if it meets all FDA requirements for a gluten-free food.

For this reason, some products, such as bottled water, are unlikely to have a gluten-free label even though they do not contain gluten.

Is all food labeled?

The FDA also encourages restaurants to adopt gluten-free labeling, for the benefit of customers, and to work with local and state governments to oversee this.

The FDA does not prescribe any particular type of labeling, or recommend a location for the label, "as long as it doesn't interfere with mandatory labeling information and meets the regulatory requirements."

They point out that some organizations offer gluten-free certification. While the FDA does not endorse any specific certification program or labeling, they accept it.

Not all products are labeled, but all foods and beverages must comply with the regulation that if it does carry a gluten-free label, it must contain less than 20 ppm of gluten. This includes packaged foods, dietary supplements, fruits, vegetables, eggs in their shells, and fish.

Items that are not covered include meat, poultry, some egg products, as these are regulated by the U.S. Department of Agriculture (USDA), and most alcoholic beverages, as these are covered by the Alcohol and Tobacco Tax and Trade Bureau. (TTB).

Who should avoid gluten?

Celiac disease is an immune system disorder that is believed to affect around 3 million Americans. It normally appears in childhood, but it can affect people at any age. The exact cause remains a mystery, but it appears to run in families.

In a person with celiac disease, gluten causes the immune system to react, resulting in damage to the absorptive surface of the small intestine.

This prevents vital nutrients - fats, carbohydrates, proteins, vitamins and minerals - from being absorbed into the bloodstream.

The gluten protein that causes this reaction are the prolamins known as gliadin, secalin, and hordein. Wheat contains gliadin, barley secalin, and rye hordein. Some varieties of oats may contain a form of gluten, and some types may have it because of cross-contamination. Crossbred grains, such as triticale, can also contain gluten.

People who need to avoid gluten should inspect labels carefully before they buy.

The FDA's labeling system makes it easier for people with celiac disease to choose from a range of products that contain less than 20 ppm, available in many grocery stores.

These include gluten-free breads, sausages, cereals and so on. It is important to read and consider the labels carefully. "Wheat-free," for example, does not necessarily mean gluten-free.

Many other products contain hidden gluten, for example, in the flavorings. Rice may be gluten-free, but puffed rice cereal, for example, can contain malt flavoring, with gluten.

Soups and sauces, processed fruits and vegetables, candies, such as licorice, and pre-prepared smoothies may all contain gluten, as can such sundry items as medications, lip-balms, and vitamin supplements.

Drinks and liquids made with malt that are not distilled, such as beers and malt vinegars, will also contain gluten.

The FDA's "gluten-free" regulation has made it easier for people with celiac disease to choose appropriate foods, but it is important to read the label carefully.

From April 2013, manufacturers had one year in which to comply with the new rule. Now, any company that uses the label inaccurately can face regulatory action by the FDA.

The FDA encourages people who become sick after eating any product to seek medical care, and then to contact the FDA.

If the person suspects incorrect food labeling, they are advised to report it to Medwatch, the FDA's program for providing safety information and reporting adverse events.

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